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1.
Ann R Coll Surg Engl ; 102(5): e107-e110, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233872

RESUMO

The brain is a particularly rare site of metastasis from papillary microcarcinoma, with only few cases described in the literature. We present a case of 59-year-old man who presented with seizures and dysphasia due to left frontal lobe cystic mass, which was excised and turned out on histopathology to be of thyroid origin. Total thyroidectomy was performed and histology showed multifocal papillary microcarcinoma with the largest focus of 3mm with no other adverse features. The patient had ablative radioactive iodine postoperatively, with subsequent exit scan showing no uptake in the brain. Follow-up brain magnetic resonance imaging showed continuous regression of the surgical cavity. Although rare, such cases should be aggressively treated and followed up over the long term, because of reported associated high mortality.


Assuntos
Neoplasias Encefálicas/diagnóstico , Carcinoma Papilar/diagnóstico , Procedimentos Neurocirúrgicos , Convulsões/etiologia , Neoplasias da Glândula Tireoide/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Carcinoma Papilar/secundário , Carcinoma Papilar/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/secundário , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
2.
J Surg Oncol ; 121(6): 958-963, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32189352

RESUMO

The incidence of papillary thyroid microcarcinoma (microPTC) has dramatically increased in the last decades. Most of these tumors remain small and clinically "silent", only small number progress. Although thyroid surgery used to be the only therapeutic approach, recent guidelines now consider active surveillance for low-risk microPTC. For this reason, more accurate risk stratification of microPTC is needed. The optimal management of low-risk microPTC through accurate risk stratification represents a major clinical issue.


Assuntos
Carcinoma Papilar/diagnóstico , Carcinoma Papilar/terapia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/terapia , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Humanos , Estadiamento de Neoplasias , Fatores de Risco , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
3.
Int J Mol Sci ; 20(19)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31575031

RESUMO

Hereditary cancers with cancer-predisposing mutations represent unique models of human oncogenesis, as a driving oncogenic event is present in germline. Currently, there are no satisfactory models to study these malignancies. We report the generation of IPSC from the somatic cells of a patient with hereditary c-met-mutated papillary renal cell carcinoma (PRCC). From these cells we have generated spontaneous aggregates organizing in structures which expressed kidney markers such as PODXL and Six2. These structures expressed PRCC markers both in vitro and in vivo in NSG mice. Gene-expression profiling showed striking molecular similarities with signatures found in a large cohort of PRCC tumor samples. This analysis, applied to primary cancers with and without c-met mutation, showed overexpression of the BHLHE40 and KDM4C only in the c-met-mutated PRCC tumors, as predicted by c-met-mutated embryoid bodies transcriptome. These data therefore represent the first proof of concept of "hereditary renal cancer in a dish" model using c-met-mutated iPSC-derived embryoid bodies, opening new perspectives for discovery of novel predictive progression markers and for drug-screening for future precision-medicine strategies.


Assuntos
Carcinoma Papilar/etiologia , Carcinoma de Células Renais/etiologia , Corpos Embrioides/citologia , Células-Tronco Pluripotentes Induzidas/citologia , Células-Tronco Pluripotentes Induzidas/metabolismo , Mutação , Proteínas Proto-Oncogênicas c-met/genética , Alelos , Carcinoma Papilar/diagnóstico , Carcinoma de Células Renais/diagnóstico , Corpos Embrioides/metabolismo , Corpos Embrioides/ultraestrutura , Imunofluorescência , Expressão Gênica , Genótipo , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética/métodos , Reprodutibilidade dos Testes
4.
World J Gastroenterol ; 25(36): 5569-5577, 2019 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-31576101

RESUMO

BACKGROUND: Intraductal papillary neoplasm of the bile duct (IPNB) is a type of tumor that presents in the intra- or extrahepatic bile ducts. Cystic-type intrahepatic IPNB often mimics simple liver cysts, making the diagnosis difficult. Because the growth of IPNB is slow, careful follow-up and timely therapeutic intervention is recommended. There are few reports with a follow-up period longer than a decade; thus, we report the case of a patient with an IPNB that grew for over 13 years. CASE SUMMARY: A 65-year-old man was diagnosed, 13 years prior with a cystic hepatic tumor with abnormal imaging findings. The targeted tumor biopsy results showed no malignancy. Biannual follow-up examinations were performed because of the potential for malignancy. The cystic lesions showed gradual enlargement over 11 years and a 4 mm papillary proliferation appeared on the cyst wall, which is compatible with IPNB. The tumor was observed for another 2 years because of the patient's wishes. The imaging findings showed enlargement to 8 mm and a new 9 mm papillary proliferation of the cystic tumor. Contrast-enhanced ultrasonography showed hyperenhancement during the arterial phase in both cyst walls, indicating intraductal tumor progression in both tumors. Thus, liver segment 8 subsegmentectomy was performed. The pathological findings indicated that the tumors contained mucin, and high-grade atypia was observed in the papillary lesions, showing IPNB. CONCLUSION: The development of IPNB should be monitored in patients with cystic lesions and ultrasonography are useful tool for the evaluation.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/patologia , Carcinoma Papilar/diagnóstico , Cistos/patologia , Idoso , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Biópsia , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Colangiografia , Cistos/cirurgia , Hepatectomia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
5.
Cir Cir ; 87(S1): 62-67, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501633

RESUMO

Background: Primary hyperparathyroidism (PHPT) is characterized by an increase in parathyroid hormone (PTH) and hypercalcemia, which, when present during pregnancy, increases both maternal and fetal morbidity and mortality. Objective: Emphasize the importance of surgical intervention in primary hyperparathyroidism during pregnancy. Clinical case: A 27-year-old female with a pregnancy of 27.2 weeks of gestation, with a diagnosis of symptomatic primary hyperparathyroidism secondary to parathyroid adenoma, a history of nephrolithiasis and severe acute pancreatitis, surgery was decided upon finding intrathyroid right parathyroid adenoma, post-surgical course with adequate evolution and remission of hyperparathyroidism. Conclusions: Parathyroidectomy in primary hyperparathyroidism during pregnancy is safe.


Assuntos
Adenoma/complicações , Hiperparatireoidismo Primário/etiologia , Neoplasias das Paratireoides/complicações , Paratireoidectomia , Complicações Neoplásicas na Gravidez/cirurgia , Doença Aguda , Adenoma/diagnóstico , Adenoma/cirurgia , Adulto , Transfusão de Componentes Sanguíneos , Cálcio/metabolismo , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/cirurgia , Feminino , Hormônios/sangue , Humanos , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/sangue , Achados Incidentais , Nefrolitíase/etiologia , Pancreatite/etiologia , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/cirurgia , Gravidez , Complicações Neoplásicas na Gravidez/sangue , Complicações Neoplásicas na Gravidez/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
6.
Anticancer Res ; 39(8): 4569-4573, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366561

RESUMO

BACKGROUND/AIM: The aim of this study was to examine the clinicopathological features of intraductal papillary neoplasm of the bile duct (IPNB) and investigate their relationships with intraductal papillary mucinous neoplasm (IPMN). PATIENTS AND METHODS: Our study included 104 patients who underwent resection of tumors that showed papillary growth within the bile duct and pancreas. RESULTS: Comparisons were performed based on subtypes and histological grades. The presence of various histological grades was confirmed in both the IPNB group and the IPMN group, and statistical significance was found in the between-group comparisons of subtypes and histological grades. It was shown that while all patients who underwent IPNB resection did not match the classifications proposed by Nakanuma et al., they did reflect classification characteristics. CONCLUSION: IPNB and IPMN have common clinical histological features. Common features between IPNB subtype classifications were also identified, which may provide novel diagnostics.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/patologia , Carcinoma Papilar/diagnóstico , Neoplasias Intraductais Pancreáticas/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/cirurgia , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatectomia , Neoplasias Intraductais Pancreáticas/patologia , Neoplasias Intraductais Pancreáticas/cirurgia
7.
Acta Myol ; 38(2): 37-40, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31309181

RESUMO

Inflammatory myopathies comprise a group of rare autoimmune muscle diseases characterized by a variable degree of muscle weakness, elevated creatine kinase levels and necrotic fibres associated with invading inflammatory cells at histologic examination. Although there are several reports about their relationship with malignancy, association with papillary cancer of the thyroid gland is extremely rare. We present a case of a female patientdiagnosed withinflammatory myopathy and apapillary cancer of the thyroid gland, with a remarkable clinical improvement after thyroid cancer surgery and radioactive iodine treatment, supporting a correlation between the two conditions.


Assuntos
Carcinoma Papilar/complicações , Carcinoma Papilar/diagnóstico , Miosite/etiologia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/diagnóstico , Carcinoma Papilar/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Miosite/diagnóstico , Miosite/terapia , Neoplasias da Glândula Tireoide/terapia
8.
Diagn Pathol ; 14(1): 75, 2019 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-31299983

RESUMO

BACKGROUND: The bone formation within bladder tumors could be encountered in 3 conditions. These might consist of malignant bone formation in mesenchymal tumors; mixed mesenchymal and epithelial tumors; and epithelial tumors with stromal osseous metaplasia (SOM). This last is relatively rare. According to the English literature, only 12 cases have been reported in primary tumor and 7 in metastatic deposits of bladder primaries. Herein, we presented an additional case. CASE PRESENTATION: An 83-year-old man was admitted 13 years ago for prostatic adenocarcinoma, treated with radical prostatectomy. Biochemical recurrence was detected 2 years after surgery (prostate-specific-antigen (PSA) level: 4.60 ng/mL) and progressively normalized (<1.0 ng/mL) after adjuvant radiotherapy and annual injection of leuprorelin (enantoneR). He was referred after 8 years for hematuria, PSA level having slightly increased (0.60 ng/ml). Cystoscopy showed a nodular growth in the bladder wall, visualized as a calcified tumor on computed tomography (CT) and removed with transurethral resection. Histologically, the tumor consists of a non-muscle-invasive high grade papillary urothelial carcinoma with metaplastic bone within the stroma. Immunohistochemical analysis particularly demonstrated positive expression of respectively CD56 on osteoblasts, and CD68 on osteoclasts. MDM2 and CDK4 were negatives on osteoid and bone tissue. Six courses of Bacillus Calmette-Guerin (BCG) therapy have been administered. Two local recidives have occurred during an 8-month follow-up period after immunotherapy and were treated with six further courses of BCG therapy. At one-month follow-up, the patient was well without remaining symptoms. CONCLUSION: SOM is a rare benign condition whose pathogenesis remains uncompletely defined. Sarcomatoïd carcinoma represents the main differential diagnosis that influences therapeutic procedures. Prognosis depends essentially on the extent of the carcinomatous component .


Assuntos
Carcinoma Papilar/diagnóstico , Metaplasia/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias Urológicas/diagnóstico , Idoso de 80 Anos ou mais , Carcinoma Papilar/patologia , Diagnóstico Diferencial , Seguimentos , Humanos , Imuno-Histoquímica , Masculino , Metaplasia/patologia , Prognóstico , Células Estromais/patologia , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias Urológicas/patologia , Urotélio/patologia
9.
Medicine (Baltimore) ; 98(27): e16386, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277195

RESUMO

The incidence of papillary thyroid microcarcinoma (PTMC) has increased dramatically in recent years. Compared with central lymph node metastases, lateral neck lymph node (LNLN) metastases in patients with PTMC were less studied. The aim of the present study is to analyze the predicting factors associated with LNLN metastases in patients with PTMC.A total of 3514 patients underwent thyroid surgery at our hospital from January 2017 to December 2017, and 936 patients with PTMC were selected and assessed retrospectively. They were further divided into 2 groups based on whether LNLN metastases existed or not. The relationship between LNLN metastases and clinicopathologic features of PTMC was analyzed.LNLN metastases were confirmed in 126 patients. Univariate and multivariate analyses found 5 independent factors associated with LNLN metastases. They were tumor size (≥0.7 cm) [odds ratio (OR) = 1.960, 95% confidence interval (95% CI) 1.227-3.131; P = .005], multifocality (OR = 2.254, 95% CI 1.398-3.634; P = .001), tumor location (upper portion) (OR = 6.312, 95% CI 3.853-10.340; P < .001), thyroid cancer family history (OR = 7.727, 95% CI 2.227-26.818; P = .001), and central lymph node metastases (OR = 11.810, 95% CI 6.547-21.302; P < .001).The findings of our study indicated that LNLN metastases were not rare in patients with PTMC, and tumor size (≥0.7 cm), multifocality, tumor location (upper portion), thyroid cancer family history, and central lymph node metastases were independent factors for LNLN metastases. In order to perform individualized management, LNLN should be meticulously evaluated when these features are detected.


Assuntos
Carcinoma Papilar/secundário , Neoplasias da Glândula Tireoide/secundário , Adolescente , Adulto , Idoso , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/terapia , Feminino , Humanos , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Pescoço , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia , Adulto Jovem
10.
Int J Surg Pathol ; 27(7): 736-743, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31187678

RESUMO

The histologic distinction between papillary breast lesions remains challenging, especially with core biopsy (CB) specimens. A retrospective review of the clinical, imaging, and histologic findings was performed for patients with papillary breast lesions on CB from 2013 to 2017. The interpretation accuracy was expressed as upgrade rate relative to the excision diagnosis. Diagnostic reproducibility with and without immunohistochemistry was analyzed as interobserver variability among 3 board-certified pathologists. Among 57 papillary lesions with biopsies and excisions available for review, the upgrade rates were 0% for benign papilloma, 30% for papilloma with atypical ductal hyperplasia, and 25% for papilloma with ductal carcinoma in situ, resulting in an overall upgrade rate of 11.1%. There were no statistical differences between patients in an upgrade group and others, when comparing the patient age, clinical presentation, BI-RADS (Breast Imaging Reporting and Database System) category, location, and histologic grade. The overall interobserver variability of the 60 consecutive core biopsies of papillary breast lesions by morphology alone was in the "substantial" agreement range (κ = 0.79, 86% agreement), with an excellent κ score of 0.88 for papilloma (92% agreement). "Substantial" and "fair" κ values were seen for papilloma with atypical ductal hyperplasia/ductal carcinoma in situ (0.74, 84% agreement) and invasive carcinoma (0.40, 60% agreement). Use of immunohistochemical stains improved the κ values into "excellent" range (0.92, 94% agreement). Our study favors a conservative approach in the management of benign papillomas, at least in cases of good radiologic-pathologic concordance. Papillary breast lesions with atypia/malignancy show lower diagnostic reproducibility on CB, and utility of immunohistochemistry is recommended in challenging cases.


Assuntos
Neoplasias da Mama/diagnóstico , Mama/patologia , Carcinoma Intraductal não Infiltrante/diagnóstico , Carcinoma Papilar/diagnóstico , Papiloma/diagnóstico , Fatores Etários , Biópsia com Agulha de Grande Calibre/estatística & dados numéricos , Mama/diagnóstico por imagem , Mama/cirurgia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Feminino , Humanos , Hiperplasia/diagnóstico , Hiperplasia/patologia , Hiperplasia/cirurgia , Imuno-Histoquímica , Mamografia , Mastectomia , Pessoa de Meia-Idade , Variações Dependentes do Observador , Papiloma/patologia , Papiloma/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos
11.
J Cancer Res Ther ; 15(3): 665-668, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31169237

RESUMO

Background: Blood supply to the thyroid is relatively high when compared to that of liver. Despite this documented metastatic deposit in thyroid remains a rarity. Synchronous nonthyroidal metastatic deposit in thyroid from a lung primary is relatively rare. Metastasis to thyroid portends to poor prognosis, and hence a metastatic deposit has to be excluded in any suspicious lesion of thyroid. Materials and Methods: Details of a rare presentation of a malignant thyroid lesion, a secondary deposit from an asymptomatic primary papillary adenocarcinoma of lung, who had presented to this tertiary care center was retrieved and analyzed. Results: Patient with an initial diagnosis of papillary carcinoma on FNA was taken up for total thyroidectomy and cervical lmphadenectomy. HPR was mucinous carcinoma of thyroid with high lymph nodal metastasis. In view of the exrathyroidal disease an adjuvant external beam radiotherapy was considered for him. Unfortunately, the radiotherapy planning CT scan revealed left sided lung lesions with pleural effusion which was proved to be papillary adenocarcinoma of lung on biopsy, with metastases to thyroid. He was treated with chemotherapy but he succumbed to his illness 9 months from the date of diagnosis. Conclusion: Although encountered rarely, metastatic lesions in thyroid from nonthyroidal primaries need to be excluded while evaluating thyroid lesions.


Assuntos
Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/secundário , Biópsia , Carcinoma Papilar/diagnóstico , Terapia Combinada , Diagnóstico Diferencial , Erros de Diagnóstico , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Neoplasias da Glândula Tireoide/terapia , Nódulo da Glândula Tireoide/diagnóstico , Resultado do Tratamento
12.
Ann Surg Oncol ; 26(9): 2738-2746, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31147995

RESUMO

BACKGROUND: Among patients with a core biopsy diagnosis of ductal carcinoma in situ (DCIS), approximately 10% have microinvasion (DCISM), which, like DCIS, is subject to upstaging by surgical excision, but for which the rates of T and N upstaging are unknown, as is the role of sentinel lymph node biopsy (SLNB), since current studies of SLNB for DCISM are based on the final pathologic report, not the core needle biopsy. In this study, we identified the rates of T and N upstaging following surgical excision in patients with a suspected versus definite core needle biopsy diagnosis of DCISM. METHODS: Overall, 369 consecutive patients (2007-2017) with a core biopsy diagnosis of suspected versus definite DCISM and surgical excision were stratified by extent of DCISM on core biopsy: suspicious focus, single focus, multiple foci/single biopsy, and multiple foci/multiple biopsies. Within strata, we identified clinicopathologic features associated with T and N upstaging. RESULTS: Across core biopsy strata, there were no clear differences in imaging characteristics or median invasive tumor size (0.2 cm). Among 105 patients with a core biopsy suspicious for DCISM versus 264 with definite DCISM, 28% and 37%, respectively, were upstaged to at least pT1a, but only 1% and 6%, respectively, to pN1. CONCLUSIONS: Although 28% of patients with suspected DCISM on core biopsy were surgically upstaged to invasive cancer, the frequency of pN1 SLN metastasis (1%) was comparable with that of DCIS, and was insufficient to recommend SLNB at initial surgery. SLNB remains reasonable for patients with definite DCISM on core biopsy.


Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/normas , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Idoso , Biópsia com Agulha de Grande Calibre , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/cirurgia , Feminino , Seguimentos , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Invasividade Neoplásica , Prognóstico , Estudos Retrospectivos , Fatores de Risco
13.
Ann R Coll Surg Engl ; 101(7): e160-e163, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31219312

RESUMO

We describe a rare case of ectopic papillary thyroid cancer in the thyroglossal duct tract invading the floor-of-mouth musculature. The postablative defect was reconstructed with a bone-anchored tensor fascia lata graft to resuspend the floor of mouth to the mandible as a neogeniohyoid sling, enabling maintenance of a functional tongue position for normal speech and swallowing. This reconstruction should be considered when suprahyoid musculature is resected without breaching the oral lining.


Assuntos
Carcinoma Papilar/cirurgia , Coristoma/cirurgia , Fascia Lata/transplante , Neoplasias Bucais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cisto Tireoglosso/cirurgia , Glândula Tireoide , Adulto , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/patologia , Coristoma/diagnóstico , Coristoma/patologia , Feminino , Humanos , Osso Hioide/cirurgia , Imagem por Ressonância Magnética , Soalho Bucal/diagnóstico por imagem , Soalho Bucal/cirurgia , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/patologia , Esvaziamento Cervical/efeitos adversos , Invasividade Neoplásica/diagnóstico por imagem , Invasividade Neoplásica/patologia , Retalhos Cirúrgicos/transplante , Cisto Tireoglosso/diagnóstico , Cisto Tireoglosso/patologia , Tireoidectomia/efeitos adversos , Resultado do Tratamento , Adulto Jovem
14.
J Cancer Res Clin Oncol ; 145(8): 2131-2140, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31227894

RESUMO

PURPOSE: This study aimed at determining the relationship between classification according to the papillary tumor pattern of carcinoma in situ (CIS) of the bladder and prognosis, as this has not yet been well established. METHODS: This study comprised a consecutive cohort of 254 patients (primary CIS: 66 patients, stage Ta-CIS: 52 patients, and stage T1-CIS: 136 patients) with CIS-associated bladder cancer. We classified CIS according to the pathological pattern of papillary tumors and analyzed prognostic factors, including CIS classification, for progression. We evaluated progression using two endpoints: infiltrative tumors detected at stage T1 or higher or at stage T2 or higher. Bacillus Calmette-Guerin (BCG) immunotherapy response was defined as no recurrence within 6 months. RESULTS: Both the BCG immunotherapy response and CIS classification were significant prognostic factors for both the endpoints. Patients with CIS-associated stage Ta urinary bladder cancer had better prognosis for both the endpoints than those with stage T1 cancer or those with primary CIS. BCG immunotherapy response (p < 0.001) and age (p = 0.007) were also significant prognostic factors for the progression of stage T2 or higher infiltrative tumors. The prognosis of patients with recurrent primary CIS (12/26, 46.2%) and T1-CIS (25/45, 55.6%) was poor for progression; distant metastasis occurred in approximately 40% of these patients. CONCLUSIONS: Clinicians should consider radical surgery for poor prognosis in patients with recurrent CIS-associated T1 cancer or primary CIS. The CIS classification according to the tumor pattern reflects the prognosis.


Assuntos
Vacina BCG/uso terapêutico , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/tratamento farmacológico , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/tratamento farmacológico , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/tratamento farmacológico , Adjuvantes Imunológicos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Carcinoma in Situ/patologia , Carcinoma Papilar/patologia , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/tratamento farmacológico , Carcinoma de Células de Transição/patologia , Progressão da Doença , Feminino , Humanos , Imunoterapia/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/patologia
15.
Nihon Shokakibyo Gakkai Zasshi ; 116(5): 419-427, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31080222

RESUMO

A man in his 60s was hospitalized with multiple cerebral infarctions and referred for Trousseau's syndrome. Computerized tomography confirmed a 60-mm mass in the pancreatic head and swollen lymph nodes around the abdominal aorta. Fine needle aspiration cytology of the pancreatic lesion and laparoscopic para-aortic lymph node biopsy revealed adenocarcinoma, including clusters of invasive micropapillary carcinoma (IMPC). Chemotherapy (gemcitabine and nab-paclitaxel) markedly decreased the primary and metastatic lesions, and no recurrence was clinically detected 24 months later. To the best of our knowledge, reports of pancreatic IMPCs are rare. Our case was the seventeenth case of pancreatic cancer with IMPC. In this case, chemotherapy was markedly effective.


Assuntos
Carcinoma Papilar/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Carcinoma , Humanos , Metástase Linfática , Masculino , Recidiva Local de Neoplasia
16.
J Obstet Gynaecol Res ; 45(8): 1479-1487, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31074203

RESUMO

AIM: To examine the hysteroscopic morphological features in each histological grade of endometrial cancer, and to distinguish high- and low-grade cancer and low-grade cancer and atypical endometrial hyperplasia (AEH), using hysteroscopy. METHODS: In total, 135 patients who underwent hysterectomy after hysteroscopy were analyzed. They were divided into four categories: benign lesion; AEH; low-grade cancer, including endometrioid carcinoma grades 1 and 2 (G1/2); and high-grade cancer, including endometrioid carcinoma grade 3 and other high-grade carcinomas (G3/others). Three blinded gynecologic oncologists independently evaluated hysteroscopic video images for abnormal vessels, surface smoothness, papillary structure and polypoid structure. Prevalence rates of each finding were compared between the four categories. The accuracy of blind biopsy in outpatient settings and hysteroscopic endometrial biopsy in the four categories were also investigated. RESULTS: The number of patients with benign lesions, AEH, G1/2 and G3/others was 8, 7, 84 and 36, respectively. Patients with G3/others exhibited more polypoid (86% vs 61%, P = 0.0095) and less papillary (59% vs 80%, P = 0.023) structures than those exhibited by patients with G1/2. AEH and G1/2 were indistinguishable using hysteroscopy. Hysteroscopic biopsy was more accurate than outpatient biopsy in patients with G3/others (84% vs 52%, respectively, P = 0.010). Both biopsies were not sufficiently accurate to diagnose AEH (outpatient; 0%, hysteroscopic; 57%). CONCLUSION: Hysteroscopic papillary and polypoid structures can help distinguish between high- and low-grade cancer. Hysteroscopic differentiation between AEH and low-grade cancer is difficult. These findings are considerable in preoperative assessment to determine adequate surgical strategies.


Assuntos
Carcinoma Endometrioide/diagnóstico , Carcinoma Papilar/diagnóstico , Hiperplasia Endometrial/diagnóstico , Neoplasias do Endométrio/diagnóstico , Histeroscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma Endometrioide/patologia , Carcinoma Papilar/patologia , Hiperplasia Endometrial/patologia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade
17.
G Chir ; 40(2): 81-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31131805

RESUMO

Particular interest is now being given to the best treatment of papillary thyroid microcarcinoma (PTMC) due to its significantly increased incidence. PTMC typically shows indolent organic behavior but, in a low percentage of cases, it can express a relative aggressive behavior. Several risk factors have been shown to negatively influence the rate of regional recurrences and metastases such as tumor diameter, Romaage, sex, multifocality, capsular invasion, extracellular diffusion, lymph node metastases, histological variants, mutated Braf and incidentality. The identification of patients with aggressive PTMCs among the majority with low risk lesions is very important to plan an adequate clinical management, thus the most appropriate surgical treatment. The latter includes thyroid lobectomy and total thyroidectomy with central compartment lymphadenectomy, though several studies did not show statistically significant differences in terms of recurrence and mortality rates between the two techniques. At last, it seems crucial to better define those biological features able to improve selection making process of patients with PTMCs aiming to reserve more radical surgery to those patients carrying more aggressive clinicopathologic features and worse prognosis.


Assuntos
Carcinoma Papilar/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Carcinoma Papilar/diagnóstico , Humanos , Prognóstico , Fatores de Risco , Neoplasias da Glândula Tireoide/diagnóstico
18.
Ear Nose Throat J ; 98(5): 295-298, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30961385

RESUMO

Clinically, it may be very difficult to differentiate between benign branchial cleft cyst (BCC) and malignant BCC with papillary carcinoma preoperatively. Radiological features were reviewed retrospectively between benign BCC and malignant BCC with papillary carcinoma using computed tomography (CT) and magnetic resonance (MR) images. All patients had only a mass on the right upper lateral neck without lesion in the thyroid gland. Two patients had a mass in the upper medial part of BCC on CT images and one patient showed a well-circumscribed mass in the upper portion of BCC on MR image. Two patients received BCC removal only and one patient underwent total thyroidectomy including removal of BCC. As results, most cases of papillary carcinoma in the BCC were detected incidentally after surgical resection of BCC. However, we can differentiate between benign BCC and malignant BCC with primary papillary carcinoma by carefully reviewing radiologic images before surgery.


Assuntos
Branquioma , Carcinoma Papilar , Esvaziamento Cervical/métodos , Pescoço/diagnóstico por imagem , Neoplasias da Glândula Tireoide , Tireoidectomia/métodos , Adulto , Branquioma/diagnóstico , Branquioma/patologia , Branquioma/cirurgia , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Cuidados Pré-Operatórios/métodos , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tomografia Computadorizada por Raios X/métodos
19.
Breast Dis ; 38(2): 67-72, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30988233

RESUMO

BACKGROUND: The management of papillary lesions is controversial with studies showing different rates of upstaging to malignancy. There is a paucity of research into race as an independent risk factor. The aim of this study is to identify if race is correlated with upstaging to malignancy with a secondary focus of analyzing for other personal and tumor specific risk factors for upstaging. METHODS: We performed a retrospective review of 123 papillary lesions with univariate analysis to identify risk factors for upstaging. RESULTS: The incidence of papillary lesions found on core needle biopsy was 6%. Atypical papillary lesions were most likely to be upstaged to malignancy at a rate of 27.7%. Papillary lesions and papillary lesions with hyperplasia were also upstaged to cancer at a lower rate of 8.3% and 12.5%, respectively. A univariate analysis of all papillary lesions and a separate analysis of atypical lesions demonstrated a higher likelihood of upstage based on BIRADS classification. Race, age, size of tumor and other radiographic features were not associated with an increased risk for upstaging to malignancy. CONCLUSIONS: Atypia remains the most significant contributor to the risk of upstaging papillary lesions to malignancy. Our research supports the practice of excising all atypical papillary lesions with selected excision of those without atypia. In our cohort, there was no association between race and risk of upstaging to malignacy.


Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma Papilar/cirurgia , Papiloma Intraductal/classificação , Fatores Raciais , Idoso , Biópsia com Agulha de Grande Calibre , Mama/patologia , Neoplasias da Mama/patologia , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/patologia , Feminino , Humanos , Hiperplasia/patologia , Incidência , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores de Risco
20.
Zhonghua Bing Li Xue Za Zhi ; 48(4): 288-292, 2019 Apr 08.
Artigo em Chinês | MEDLINE | ID: mdl-30955264

RESUMO

Objective: To investigate the prevalence of BRAF V600E mutation in thyroid nodules and to analyze the relationship between BRAF V600E mutation and various clinicopathological features. Methods: BRAF V600E mutant gene test was done in 463 cases of thyroid nodules collected from April 2015 to July 2018 in Beijing Hospital. Pathologic sections of 444 cases of papillary thyroid carcinoma were reviewed and clinical information was collected.Statistical analysis of the relationship between BRAF V600E gene mutation and various clinicopathological features was performed with SPSS 21.0 statistical software. Results: There were 109 males and 354 females in the cohort, with a male to female ratio of 1.0∶3.2. The patient ranged in age from 16 to 82 years, with an average age of 46.1 years. The BRAF V600E mutation rates in papillary thyroid carcinoma, benign thyroid nodules and other thyroid carcinoma were 86.5%(384/444),0/15 and 1/4,respectively.There was significant correlation between BRAF V600E mutation and histological diagnosis of papillary thyroid carcinoma (P<0.05). There was no correlation with age, gender, multifocality, bilaterality, coexisting lymphocytic thyroiditis, nodular goiter, maximum diameter, capsule invasion, extrathyroidal extension and clinical stage (P>0.05). Conclusions: BRAF V600E gene mutation is closely related to the occurrence of papillary thyroid carcinoma. BRAF V600E has significant value in the diagnosis of papillary thyroid carcinoma. While BRAF V600E mutation is related to the histological diagnosis, it shows no correlation with other clinicopathologic features. BRAF V600E mutation is not an independent prognostic factor in papillary thyroid carcinoma patients.


Assuntos
Carcinoma Papilar/genética , Mutação , Proteínas Proto-Oncogênicas B-raf/genética , Câncer Papilífero da Tireoide/genética , Neoplasias da Glândula Tireoide/genética , Nódulo da Glândula Tireoide/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Papilar/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Câncer Papilífero da Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Adulto Jovem
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